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目的分析大剂量利尿素对存在利尿剂抵抗的心力衰竭患者的临床治疗效果。方法 280例心力衰竭伴有利尿剂抵抗的顽固心力衰竭患者,心功能均为Ⅲ~Ⅳ级,均进行病因纠正、吸氧,并给予血管转换酶抑制剂以及洋地黄等,经上述治疗无效,采取大剂量利尿剂进行治疗,持续泵注呋塞米10~40 mg/h,确保尿量在1500 ml。观察患者采用大剂量利尿剂治疗前后的胸片、心功能等相关情况。结果经1~3 d大剂量利尿剂进行治疗后,280例患者心力衰竭症状得到明显缓解,其中显效90例(32.14%),有效166例(59.29%),无效24例(8.57%),总有效率为91.43%。280例患者治疗后平均心率(HR)、左心室每搏输出量指数(LVS)、心胸比率、左心射血分数(LVEF)等指标均显著低于治疗前(P<0.05)。280例患者中13例(4.64%)患者发生耳鸣症状,治疗时始终观测电解质,并进行电解质平衡维持,未见肾功能出现不良变化。结论通过大剂量利尿剂持续泵注能够有效改善存在利尿剂抵抗心力衰竭患者的临床症状,改善心率、心功能,值得推广。
Objective To analyze the clinical effect of high-dose diuretic on patients with heart failure with diuretic resistance. Methods A total of 280 patients with refractory heart failure with congestive heart failure and diuretic resistance were all treated with grade Ⅲ ~ Ⅳ heart disease. All patients were corrected for etiology, oxygen inhalation, angiotensin converting enzyme inhibitors and digitalis, Take high-dose diuretics for treatment, continuous infusion of furosemide 10 ~ 40 mg / h, to ensure that the urine output in 1500 ml. Observed patients with high-dose diuretic before and after treatment of chest X-ray, cardiac function and other related conditions. Results After treatment with high-dose diuretics for 1-3 days, symptoms of heart failure in 280 patients were significantly relieved. Among them, 90 (32.14%) were effective, 166 (59.29%) were effective, 24 (8.57%) were ineffective, The effective rate is 91.43%. After treatment, the average heart rate (HR), left ventricular stroke volume index (LVS), cardiothoracic ratio, and left ventricular ejection fraction (LVEF) were significantly lower than those before treatment (P <0.05). Tinnitus symptoms occurred in 13 of 280 patients (4.64%). Electrolytes were observed during treatment and electrolyte balance was maintained. No adverse changes in renal function were observed. Conclusions Continuous bolus injection of high-dose diuretic can effectively improve the clinical symptoms of patients with diuretic resistance to heart failure and improve heart rate and heart function, which is worth promoting.